Age may matter in determining which long-stay residents are sent to hospitals most often, but not in the way most people probably expect.
A study of nearly 1,200 patients has surprisingly found that long-stay nursing home residents younger than 60 are transferred to hospitals twice as often as residents 80 and older.
Researchers from the Regenstrief Institute and Indiana University School of Medicine explained that their analysis demonstrates annual hospital transfer rates actually decreased with age, albeit in a non-linear fashion.
Transfer rates were highest in the under-60 group and then decreased slowly between ages 60 and 80; the decline accelerated after 80, and especially after 90, the researchers reported. Full results are pending publication in Age and Ageing after appearing online first.
“There is a significant population of younger people cared for in nursing homes and little is known about them and how best to tailor quality improvement programs to meet their needs,” study co-author Kathleen Unroe, M.D., of Regenstrief Institute and IU School of Medicine said in a release first publicizing the findings Thursday. “This paper highlights some key differences in the nursing home population by age.”
Where differences lie
Some of those differences come down to clinical profiles, with younger residents experiencing more sepsis, daily pain, anemia and requiring more dialysis or tube feeding. Older residents were more likely to have cognitive decline, dementia and diabetes, and they would be more likely to have advance care documentation reflecting preferences for comfort care rather than aggressive treatment.
Hospital readmissions are associated with infections, and functional and cognitive decline. Both hospitals and skilled nursing facilities can be financially penalized when their patients return too often to acute-care settings. But previous research hasn’t clearly determined how likely younger nursing home residents are to be sent out for emergency care.
For this research, researchers tapped an existing 2015-16 study of nursing home residents called Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care. During the observation period, 679 residents had at least one documented transfer, while 508 residents had none. There were 1,096 total hospital transfers, with 168 (15.3%) involving residents younger than 60. The under-60 cohort made up just over 9% of the patient sample.
“It is estimated that about one in six long-stay nursing home residents in the United States is younger than age 65,” explained lead author Wanzhu Tu, Ph.D., of the Regenstrief Institute and IU School of Medicine. “Knowing and understanding age-specific rates of hospital transfers, as we now do, could support benchmarks for care provision and help in the design of targeted strategies to reduce hospital transfers that better recognize and address the diverse needs of nursing home residents of different ages, especially younger residents.”
The research was supported by the Centers for Medicare & Medicaid Services, which monitors rehospitalization rates and can penalize providers for missing targets. The authors hope the findings will inform practice, policies and practitioners’ mindsets.
“The current study highlights the limitation of defining the care needs of nursing home residents solely by their illnesses,” the researchers wrote. “As hospitalizations of nursing home residents continue to be a high-priority topic, these findings support the development of new interventions that better recognize and address the diverse needs of nursing home residents of different ages.”